Topical steroids

Also known as topical steroids.

Steroid creams and ointments (topical steroids) are used to reduce inflammation and itchiness in skin conditions such as eczema or dermatitis.

What are topical steroids?

Topical steroids are used to reduce inflammation and itchiness in skin conditions such as eczema, dermatitis or psoriasis.

They are also known as topical corticosteroids, glucocorticosteroids and cortisone.
Topical steroids work by reducing inflammation and the amount of collagen in your skin, which may ease symptoms such as itchiness and redness.
They are applied to your skin in the form of creams, ointments, lotions or solutions.
For skin conditions associated with dryness, such as eczema, other treatments such as emollients and moisturisers may also be needed.
If an emollient and a topical corticosteroid are prescribed at the same time, one should be applied at least 30 minutes before the other. The order of application is not important.

Different types of topical steroids

There are many types and brands of topical steroids available in New Zealand that vary in potency from mild to very potent. Read more about the different types of topical steroids and formulations.

How should I apply a topical steroid?

Use topical steroids as instructed by your doctor, who will explain where, how frequently and for how long to apply the medication.
Creams or ointments are rubbed gently into the affected skin until they have disappeared.
The amount of topical steroid that you should apply is commonly measured by fingertip units (FTUs)
One FTU is the amount of topical steroid that is squeezed out from a standard tube along an adult's fingertip (the distance from the tip of the adult index finger to the first crease). This should cover an area equivalent to your two palms (as shown in the image).
View a useful video on FTUs in the resources column on this page. Read more about fingertip units .
In some instances, your doctor may ask you to use plastic to cover treated areas. Covering the treated area with plastic after applying a topical steroid increases the absorption of the steroid, but may also increase side effects. Therefore it is usually recommended only in areas of very thick skin such as the palms of your hand and soles of your feet.

Precautions before using topical steroids

Are you are taking or using any other medicines? This includes any other creams or medicated soaps you are using that are available to buy without a prescription.
Have you ever had an allergic reaction to a medicine?

If so, it’s important that you tell your doctor or pharmacist before you start using topical steroids. Sometimes a medicine isn’t suitable for a person with certain conditions or it can only be used with extra care.

What are the side effects of topical steroids?

Like all medicines, topical steroids can cause side effects, although not everyone gets them.

Side effects	What should I do?
Burning or stinging feeling	This may happen when you first start applying the treatment. It usually improves as your skin gets used to the treatment. Tell your doctor if this feeling continues.
Thinning of the skin	This tends to occur with the potent or very potent topical steroids, if a plastic covering is used or if steroids are used often or long term. It is less likely to occur with the mild or moderate topical steroids or if sterioids are only used for a short course. If it does occur, it often goes away when the treatment is stopped. Tell your doctor.
Permanent stretch marks Bruising Discolouration Thin spidery veins	These tend to occur with long-term use of topical steroids. Tell your doctor if troublesome.
May cause or worsen other skin conditions such as acne	Tell your doctor.
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product

Learn more

Topical steroids DermNet NZ
Topical corticosteroids available in New Zealand (prescription only) BPAC, NZ, 2009
Topical steroids for eczema Patient Info, UK

Useful resources for healthcare professionals

Topical corticosteroids NZ Formulary
Steroid rebound – a topical issue Medsafe, NZ, 2013
Topical corticosteroids – face facts Medsafe, NZ, 2015
Treating childhood eczema – a topical solution for a topical problem BPAC, NZ, 2015

Resources

Support

The Māori Pharmacists’ Association Ngā Kaitiaki o Te Puna Rongoā has a free phone line to answer questions whānau have about their medicines. Call 0800 664 688.

Note: This is a non-urgent service and they will get back to you within 24 hours.
For urgent health advice freephone Healthline 0800 611 116.

Brochures

5 questions to ask about your medications

Health Quality and Safety Commission, NZ, 2019

Different types of topical steroids

There are many types and brands of topical steroids available in New Zealand.

Topical steroids have varying potency and are generally grouped into four categories depending on their strength:
- mild
- moderately potent
- potent
- very potent.
Your doctor will decide on the correct strength for you depending on your condition, age and the area of your body being treated.
The stronger the product the more likely it is to cause side effects, so generally the mildest steroid that will work is used.
Generally in adults, a strong product is used to get a problem area (other than the face) under control, then a moderate or mild product may be used to maintain that control.
Topical steroids are absorbed at different rates from different parts of the body.
A steroid that works on the face may not work on the palm, and a potent steroid used for the palm may cause side effects if applied to the face. There is much greater absorption where the skin is thin, for example, eyelids, genitals and skin creases, compared to thicker skinned areas, such as palms of your hands and soles of your feet.

Description	Example
Mild steroids These are usually used to treat mild skin conditions such as inflammation (redness) associated with nappy rash or mild atopic eczema in children. These steroids are also available as combined products with an antibiotic or an antifungal such as Micreme H®, Pimafucort®. These can be purchased from the pharmacy without a prescription but it is best to talk to a pharmacist to make sure it is the best option for you.	Hydrocortisone 0.5% Hydrocortisone 1% DermAid Soft® Skincalm®
Moderate steroids Moderate topical steroids are 2 to 25 times as potent as hydrocortisone.	Clobetasone butyrate Eumovate® Triamcinolone acetonide Aristocort®
Potent steroids Potent topical steroids are 100 to 150 times as potent as hydrocortisone. These are used for severe inflammation. These steroids are available as combined products with an antibiotic such as Viaderm KC®, Betnovate C®, Fucicort®.	Betamethasone valerate Beta® Betnovate® Betamethasone dipropionate Diprosone® Diflucortolone valerate Nerisone® Hydrocortisone 17-butyrate Locoid® Mometasone furoate m-mometasone® Elocon® Methylprednisolone aceponate Advantan®
Very potent steroids Very potent topical steroids are up to 600 times as potent as hydrocortisone.	Clobetasol propionate Dermol® Betamethasone dipropionate Diprosone OV®

What are the different formulations?

Topical steroids are available in different formulations such as as creams, ointments, lotions, solutions or gels.
Which one to use depends on the type of skin lesion, location on your body and potential for irritation (stinging) or allergy.
- Creams are usually best to treat moist or weeping areas of skin, and they rub into the skin well.
- Ointments tend to be greasy and are usually best to treat areas of skin that are dry or thickened. They have the lowest chance of burning and stinging with application.
- Lotions are easy to apply and may be useful to treat hairy areas such as the scalp.
Topical steroids are usually only applied once or two times a day.
Absorption of the steroid into the skin depends on the formulation in which the topical steroid is delivered. Higher absorption tends to occur with ointment or gel (thus increasing the potency of the product) compared to lower absorption products such as cream or lotion.